[Code of Federal Regulations]

[Title 12, Volume 6]

[Revised as of January 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 12CFR793.4]



[Page 720-721]

 

                       TITLE 12--BANKS AND BANKING

 

            CHAPTER VII--NATIONAL CREDIT UNION ADMINISTRATION

 

PART 793_TORT CLAIMS AGAINST THE GOVERNMENT--Table of Contents

 

                          Subpart B_Procedures

 

Sec. 793.4  Administrative claims; evidence and information to be 

submitted.



    (a) Death. In support of a claim based on death, the claimant may be 

required to submit the following evidence or information:

    (1) An authenticated death certificate or other competent evidence 

showing the cause of death, date of death, and age of the decedent.

    (2) Decedent's employment or occupation at the time of death, 

including his monthly or yearly salary or earnings (if any), and the 

duration of his last employment or occupation.

    (3) Full names, addresses, birthdates, kinship, and marital status 

of the decedent's survivors, including those survivors who were 

dependent for support upon the decedent at the time of his death.

    (4) Degree of support afforded by the decedent to each survivor 

dependent upon him for support at the time of his death.

    (5) Decedent's general physical and mental condition before death.

    (6) Itemized bills for medical and burial expenses incurred by 

reason of the



[[Page 721]]



incident causing death, or itemized receipts or payments for such 

expenses.

    (7) If damages for pain and suffering before death are claimed, a 

physician's detailed statement specifying the injuries suffered, 

duration of pain and suffering, any drugs administered for pain and the 

decedent's physical condition in the interval between injury and death.

    (8) Any other evidence or information which may have a bearing on 

the responsibility of the United States for the death or the damages 

claimed.

    (b) Personal injury. (1) A written report by his attending physician 

or dentist setting forth the nature and extent of the injury, nature and 

extent of the treatment, any degree of temporary or permanent 

disability, the prognosis, period of hospitalization, and any diminished 

earning capacity. In addition, the claimant may be required to submit to 

a physical and/or mental examination by a physician employed or 

designated by the National Credit Union Administration. A copy or report 

of the examining physician shall be made available to the claimant upon 

the claimant's written request provided that claimant has, upon request, 

furnished the report referred to in the first sentence of this paragraph 

and has made or agrees to make available to the National Credit Union 

Administration any other physician's reports previously or thereafter 

made of the physical or mental condition which is the subject of his 

claim.

    (2) Itemized bills for medical, dental, and hospital expenses 

incurred, or itemized receipts of payment for such expenses.

    (3) If the prognosis reveals the necessity for future treatment, a 

statement of expected duration of and expenses for such treatment.

    (4) If a claim is made for loss of time from employment, a written 

statement from his employer showing actual time lost from his 

employment, whether he is a full or part time employee, and wages or 

salary actually lost.

    (5) If a claim is made for loss of income and the claimant is self-

employed, documentary evidence showing the amount of earnings actually 

lost.

    (6) Any other evidence or information which may have a bearing on 

the responsibility of the United States for the personal injury or the 

damages claimed.

    (c) Property damage. In support of a claim for damages to or loss of 

property, real or personal, the claimant may be required to submit the 

following information or evidence:

    (1) Proof of ownership.

    (2) A detailed statement of the amount claimed with respect to each 

item of property.

    (3) An itemized receipt of payment for necessary repairs or itemized 

written estimates of the cost of such repairs.

    (4) A statement listing date of purchase, purchase price, market 

value of the property as of date of damage, and salvage value, where 

repair is not economical.

    (5) Any other evidence or information which may have a bearing on 

the responsibility of the United States for the injury to or loss of 

property or the damages claimed.

    (d) Time limit. All evidence required to be submitted by this 

section shall be furnished by the claimant within a reasonable time. 

Failure of a claimant to furnish evidence necessary for a determination 

of his claim within 3 months after a request therefor has been mailed to 

his last known address may be deemed an abandonment of the claim. The 

claim may be thereupon disallowed.